Provider Demographics
NPI:1659057008
Name:MIANO, DHRUWA
Entity type:Individual
Prefix:
First Name:DHRUWA
Middle Name:
Last Name:MIANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:DHREWA
Other - Middle Name:
Other - Last Name:GANJAWALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 PELIZZANO DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8947
Mailing Address - Country:US
Mailing Address - Phone:575-937-9911
Mailing Address - Fax:
Practice Address - Street 1:UNM PA PROGRAM MSC 09 5040
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:575-937-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2024-0120363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical